Laparoscopic hepatectomy: indications and outcomes

Abstract

We outline the indications, evaluate the degree of invasiveness, and analyze the outcomes of laparoscopic hepatectomy, mainly in the treatment of hepatocellular carcinoma (HCC). The important considerations in determining indications for laparoscopic hepatectomy include tumor size, type, and location. Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 6 cm are suitable candidates. Concerning location, tumors in the lower segment or the left lateral segment are suitable. Regarding operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral segmentectomy is a feasible, less invasive procedure. Operative time in our recent laparoscopic hepatectomy patients has decreased, with less bleeding. Furthermore, laparoscopic hepatectomy is less invasive than conventional hepatectomy on evaluation by the Estimation of Physiolic Ability and Surgical Stress (E-PASS) scoring system. Patients recovered more quickly after laparoscopic hepatectomy, which allowed shorter hospitalization. Both the 5-year survival rate for HCC and the survival rate without recurrence were nearly identical to those of open conventional hepatectomy, although further analysis will be necessary to reach definitive conclusions. In conclusion, laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy in properly selected patients and is beneficial for patient quality of life, because it is a minimally invasive procedure when indications are strictly followed.

Evolution and revolution of laparoscopic liver resection in Japan

“…Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 6 cm were considered appropriate candidates. Regarding location, LLR was indicated for tumors in the lower segment and left lateral segment 5. After the year 2000, hybrid surgical procedures; namely, laparoscopic‐assisted liver resection and hand‐assisted laparoscopic liver resection commenced, which expanded the indication for LLR 6, 7, 8, 9…”

Laparoscopic Liver Resection in the Netherlands: How Far Are We?

“…At present, after more than 10 years of experience and following advances in laparoscopic technology, the surgical community has accepted that laparoscopic liver surgery is feasible and safe [3,7,8,10,51,52,53]. This is especially true for resection of left lateral segments and right anterior segments [4,9,11,54].…”

“…Patient benefits included less operative blood loss [6,7], less postoperative pain [5,9,10] and narcotic requirement, improved cosmetic aspects [9,12] and a shorter length of hospital stay [5,7,8,9,10,11,12] with postoperative morbidity and mortality comparable to open liver resection. In addition, the minimally invasive approach seems to be cost-effective [40,41].…”

“…Laparoscopic liver resections are technically demanding and thought to be time-consuming [4,5] but may have several important benefits for the patient compared to open liver surgery [6,7,8]. The putative advantages of this minimally invasive procedure include reduced blood loss [6,7], less postoperative pain [5,9,10], earlier recovery and shorter postoperative hospital stay [5,7,8,9,10,11,12], and improved cosmetic aspects [9,12]. Reoperations are reported to be easier due to reduced adhesions [9,10,11,12].…”

Laparoscopic resection of hepatocellular carcinoma at segment 7: the posterior approach to anatomic resection

“…On the other hand, laparoscopic hepatectomies for HCC have recently emerged with the benefits of reduced blood loss, shorter hospital stay, and less severe wound pain [2,3]. Classically, liver lesions considered suitable for laparoscopic resection were those small tumors (\4 cm) located over the anterior and left lateral segments [3]. However, we would like to expand the current indications and here we present our techniques of laparoscopic anatomical resection for a HCC that was located at right posteriosuperior segment 7.…”